On the morning of January 22, a man being held by ICE inside an Indiana state prison waited for his medication, and nobody came.
He has epilepsy. He had been prescribed Keppra since 2020, two 1,000 milligram doses a day, and missing even one dose can trigger a seizure. He had gone nearly a year without one.
That morning there was no medical staff on duty in his building to hand out the breakfast doses. Hours later he seized, hit his head, and when officers finally reached his cell they found him lying in a pool of his own blood.
A hospital glued the wound on his head shut and sent him back to the prison the same day.
Here is where it turns from negligence into something uglier. Shortly after he returned, officers told him he was being moved to a different unit. He was still coming out of the seizure, still injured, having trouble standing. He asked why.
According to the complaint, he never threatened anyone, never resisted, and never left his cell. Officers opened the port in the cell door and sprayed him in the eyes. He was blinded, burning, struggling to breathe. Before he could rinse any of it off, they cuffed him and hauled him out.
They never gave him a shower. He tried to wash the chemical off in a sink.
The ACLU of Indiana filed two federal lawsuits on his behalf this week, one against the private company paid to provide medical care at the facility and one against the officers. Ken Falk, the group’s legal director, called what happened cruel and unconstitutional.
I want to be clear about why this is a constitutional question and not just a decency question.
This man was not serving a sentence. He was a civil immigration detainee. His asylum status, granted in 2000, was revoked in 2022 after a fraud conviction, and that is the entire hand the administration has to play here.
Civil detention is legally not punishment. It exists to make sure somebody appears at a hearing. That is the exact premise the government uses to justify holding tens of thousands of people, and it comes with an obligation to provide adequate medical care. He was released in May after winning a habeas petition.
This was the second time medication went missing at that prison, and the first time somebody died
Indiana signed a two-year agreement with DHS in August 2025 to hold up to 1,000 ICE detainees at that facility. The state collects $294 per detainee per day. The first detainees arrived in October.
By February, one of them was dead.
Lorth Sim was 59, a Cambodian national who came to this country as a refugee in 1983 and became a lawful permanent resident three years later. He had Type 2 diabetes and had been prescribed metformin.
The county coroner ruled he died of cardiovascular disease with diabetes as a contributing cause. But a former nurse for the prison’s medical contractor told the Indianapolis Star that Sim never actually received the metformin, and an independent autopsy his family paid for found significant glucose in his blood.
Six weeks later, 55-year-old Tuan Van Bui died at the same facility. Two detainees who watched him collapse said help arrived too late.
When Congressman André Carson toured the prison in April, detainees told him a man had been screaming for help and staff assumed he was joking.
The same failure, over and over, in state after state
If Indiana were the only place this happened, it would be a scandal about one prison. It is not.
Human Rights Watch and Physicians for Human Rights published a joint investigation in June that walks through case after case with the same shape. Somebody says they are sick. Nobody takes it seriously. Then it is too late.
A 44-year-old Ukrainian man at the Krome facility in Florida repeatedly reported chest pain and an irregular heartbeat, and there is no record anyone prescribed him anything. When a nurse found him unresponsive with pupils that would not react to light, staff did not call 911. Workers at the facility chose to move him to the clinic and ordered non-emergency transport. He reached an emergency room four and a half hours after the first call, with a blood pressure over 280. The working theory among the staff was that he was high.
A 39-year-old Mexican man who was being held at Adelanto in California reported a fever, a cough, and a growing abscess. A provider gave him ointment and a fiber supplement and sent him on his way. No physical exam was ever documented, which is what would have found the infection. He died of septic shock. He had lived here since he was four and worked at the same car wash for 15 years.
A 42-year-old Honduran man at a county jail in New York was identified at intake as being in active alcohol withdrawal, a condition that kills people when it goes unmanaged and almost never does when it does not. He was cleared for detention within two hours. Nobody checked on him for the next 17 hours. A guard found him dead.
A 45-year-old Ethiopian man at Eloy in Arizona went to medical four separate times over six weeks and was treated for a pulled muscle every time. He had lost 20% of his body weight before anyone looked harder. He had tuberculosis, plus untreated HIV that had progressed to AIDS. He had been in general population that entire time with an active airborne infection.
Not one of those is a story about a rare disease. Every one is a story about somebody saying they were sick and being waved off.
The numbers are not close to normal
In the first 500 days of this administration, 52 people died in ICE custody. Thirty-nine people died in the first year alone, the highest annual toll since ICE was created in 2003.
The mortality rate is the highest in nearly two decades. It is roughly four times the rate under the previous administration. It is higher than it was at the peak of COVID, when detention was a documented public health disaster.
And this is not simply a function of holding more people. The detained population grew 77%. Annual deaths more than tripled.
For comparison, the average was 8.9 deaths a year between 2018 and 2024. ICE itself reported 11 deaths in 2024 and 32 deaths in 2025. At least 22 people have died so far in 2026, and we are only in July.
An earlier study of deaths between 2017 and 2021 concluded that 95% of them were preventable or possibly preventable with adequate care.
Three decisions made this happen
They deleted the penalties. The medical contractor in Indiana is Centurion Health, a subsidiary of the insurance giant Centene. It faces more than 150 active federal lawsuits in that state alone over conditions of confinement. Missouri has fined it every quarter since renewing its contract. A whistleblower suit in Delaware, in which the state attorney general joined, accuses it of falsifying records and concealing staffing shortages. When Indiana extended the contract, the state removed the clause requiring the company to pay back for missed staffing requirements, and it was renewed this March again for roughly $213 million despite all of the company’s previous issues.
They stopped paying for outside care. For more than 20 years, the Department of Veterans Affairs processed reimbursements to hospitals, pharmacies, and specialists for treating detainees offsite. ICE paid the VA for the service. On October 3, 2025, under pressure from a right-wing legal group, that arrangement was terminated. ICE handed the work to a private contractor called Acentra Health. In its own procurement documents, ICE called the situation an absolute emergency and specifically named dialysis, prenatal care, and chemotherapy as the care at risk. As of last month, Acentra had collected $44.6 million and paid providers exactly nothing. Not a reduced amount. Zero, for nine months running. Providers have started refusing these patients.
They fired the inspectors. Congress created the Office of the Immigration Detention Ombudsman in 2019 specifically to investigate deaths, medical care, and misconduct inside detention. It was an effective agency that suddenly went from more than 100 at the start of 2025 to five at the start of this year, overseeing 220 active facilities. In May, DHS closed it permanently and blamed Congress. The department’s civil rights office was gutted alongside it, with its budget cut 77% in one year.
What that looks like when nobody is watching
Camp East Montana, the tent facility on the Fort Bliss Army post in El Paso, is now the largest immigration detention site in the country. The facility was quickly opened in August 2025 under a $1.3 billion contract awarded to a company with no prior detention experience.
An ICE inspection in February found 49 violations of detention standards at that facility, including 22 tied to use of force. Inspectors flagged a failure to isolate a detainee showing symptoms of pulmonary tuberculosis and a failure to document suicide prevention checks.
At least three people have died there. One death was ruled a homicide by the El Paso County medical examiner. In that case, federal auditors reported in June that evidence was missing or destroyed.
Human Rights Watch and the ACLU interviewed 71 people held there. Roughly 90% said they had been assaulted by staff or watched somebody else be beaten.
The horrendous treatment of individuals housed in ICE detention centers reaches pregnant women too with DHS data provided to senators showing that the government deported 363 pregnant, postpartum, or nursing women between January 2025 and February 2026. As of February, 86 pregnant women were in custody, nine of them in the third trimester. Sixteen miscarriages were recorded.
ICE’s own standing policy says it generally should not be detaining these women at all.
Their answer is not surprisingly to shift blame and call it fake news
When reporters asked ICE about the deaths in Indiana, a spokesperson said claims of substandard conditions were false and added that this is the best healthcare many of these people have received in their entire lives.
When NPR asked DHS about the record death toll, the agency denied there was a spike, cited a death rate expressed as a percentage, and used the statement to encourage detainees to deport themselves. Being in detention, they said, is a choice.
Read that against the record and it’s a very different situation. A man with epilepsy seizing on a concrete floor because nobody showed up with his pills. A man with a brain bleed loaded into a van instead of an ambulance. A man with a raging infection sent back to his cell with ointment. A man dead of alcohol withdrawal 17 hours into custody. A man carrying active tuberculosis through a housing unit for six weeks.
And understand who is inside these facilities that are being run by unqualified companies and untrained workers. As of April, fewer than 18,000 of the more than 60,000 people in ICE detention had any prior criminal conviction. Roughly 24,000 had neither a conviction nor a pending charge.
None of this is an accident. Every piece of it was a decision somebody signed and decisions were made to fill facilities past capacity with people who have never been convicted of anything. The decision to hire contractors with documented histories of understaffing and then delete the penalty for understaffing. The decision to blow up a working payment system with nothing ready to replace it. The decision to fire the watchdogs.
Those choices have a body count, and it is climbing every week.
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